| NPI | 1275250474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1499060323) |
| Additional Taxonomies | 101Y00000X Counselor |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2022-10-27 |
| Last Update Date | 2023-03-03 |